How to Calculate Patient and Payer Responsibility (Copay vs Coinsurance vs Deductible)

In this video I explain the difference between copay, coinsurance, deductible and out of pocket maximum. I explain and show you how to calculate in network patient and payer responsibility.
The Billing Coaching Group provides live medical billing instruction and software training. If you want to learn the fundamentals of each stage of the revenue cycle, join us! We meet for 6 weeks on Wednesday's at 8pm EST.
The next two sessions of live training start on September 22, 2021 and November 3, 2021.
Have any questions? Email [e-mail].
www.justaskthebiller.com
/ askthebiller

[@meowser7]

You are doing the lord’s work, this is the first time it had made sense, big THANK YOU!!! ❤

[@AskTheBiller]

😂 I’m so glad to hear that! Thanks for watching.❤️

[@imcphan1]

very helpful I go to externship in a few days and this was my weakness I'm glad their letting me bring notes.

[@angelagriner8336]

Oh my gosh I love you!!!!!!!! I finally get it now I am taking my medical and billing coding exam for the 2nd time on friday You are so so helpful I will be watching you videos..

[@mistiipage3282]

Thank you so much for this video and the time you put into it, to share with us all! It's so much appreciated!

[@AskTheBiller]

You are so welcome! Thanks for watching : )

[@aggie9067]

Thank you for your video! I watched lots of videos about this topic and you clearly explained everything. You're examples helped me a lot. Thanks again!

[@AskTheBiller]

You're very welcome : )

[@toddyrich118]

Example 5 was excellent for my education on how to read my EOB! Thank you very much!!!

[@AskTheBiller]

I’m so glad it was helpful!😊

[@staceylicayan3656]

Thank you so much. I was so confused with all of this before you. The book we are using is very vague in describing how to calculate. You are an angel.

[@AskTheBiller]

You're very welcome, Stacey. So glad this video gave you clarity : )

[@magellanmando615]

I am so glad that people like you are able to make videos helping out students, this really helped me understand most of the medical billing part of the Health Insurance and Medical Billing tests in BPA. Hopefully my results improve for state BPA.

[@AskTheBiller]

I’m so glad you found this helpful.😊

[@devsai21]

GREAT !!!!!!very useful video! this is such an underrated video...people need to know all of this to survive in the US

[@AskTheBiller]

Thanks so much!❤️

[@tinagraham1386]

thank you thank you thank you! I'm currently taking an online medical billing/coder class and I was super lost! I can tell you love what you do and this gives me inspiration to keep going and not give up on this class.

[@AskTheBiller]

Thank you so much! NEVER give up. There are resources out here to assist you along your medical billing journey.

[@elizabethvonstur4317]

Thank you SO MUCH for this! I’m taking my NHA CBCS certification exam tomorrow and I am just refreshing my knowledge of patient responsibility. You make it clearer than the entire program I took. I will probably join you on Wednesday nights to learn more about the billing aspect…I have coding down but billing is still tricky for me. So happy I found you!

[@AskTheBiller]

You’re very welcome! Medical billing doesn’t have to be complicated. Wishing you all the best on your exam tomorrow!!!❤️

[@WeSelfCare]

I love the way you break this down

[@AskTheBiller]

Thank you ❤️ I hope you learned something new 😊

[@djm2985]

You are amazing! I made up my own numbers and followed your guide for ea example. I'll need to know how to calculate for my job. God bless you ❤️❤️

[@AskTheBiller]

I'm so glad this was helpful! Thanks for watching.☺

[@feliciacoleman8725]

Thank you lady! I agree with the previous notes this was spot on and very clear

[@AskTheBiller]

Thank you : )

[@CodingWithAmandaChalk]

Awesome information sis! I like to stay versatile. This brought back some things! I use to post payments! ❤️🙌🏾

[@AskTheBiller]

Thanks so much for watching and for your continued support!!

[@desireeeverett3517]

This was so helpful! Thank you

[@lovemagnet2024]

THIS VIDEO WAS SO HELPFUL. THANK YOU!!!

[@AskTheBiller]

You’re welcome!😁

[@KickinItWithShun]

Thank you so much; this video is exactly what I needed...I’ve scheduled a consultation with you later this month to get additional help in this area...you’re videos are very helpful, Thanks again 👏🏾👍🏾😌

[@AskTheBiller]

I am so glad it was helpful! Looking forward to speaking with you : )

[@davidabarrios1503]

Thank you for your help☺️

[@t3rriblethings]

you are a life saver !!!!!!!!!!

[@AskTheBiller]

Thank you! So glad this was helpful : )

[@pranavshresthanepali4650]

Thank you for the information. I have a question… How is allowed amount calculated?? On what factors does it depend?

[@MultiSexykeisha]

Enjoyed the video I hope you can do more on the calulations.You made it easier to understand.

[@AskTheBiller]

Thanks so much!! I will make more of these videos soon : )

[@tanviArts1111]

Can u please solve my query

[@ginapitalco3592]

Hi Quiana, thank you so much for this video it's very helpful. Hope you can make a video on how to read the EOB. God bless

[@AskTheBiller]

Thanks for watching, Gina. I will make an EOB video soon : )

[@user-bi8bs9nh7k]

thank you so much for this infomation!!!!!

[@AskTheBiller]

You are so welcome!😊 Thanks for watching.

[@JulieRamirez-hg2bb]

Thank you for sharing this video. I just started my MOA class on billing and felt lost. I'm interested in learning more in all the medical fields

[@AskTheBiller]

Thanks for watching, Julie!

[@SocaTrain]

I can’t stop saying thank you for these vids!

[@AskTheBiller]

You're very welcome!! If I only had the time to make much more LOL.

[@ashleyvolter2213]

I’m soooo glad I found your channel!!! A Godsend!!! Thank you so much!!! 🫶🏾🫶🏾🫶🏾🙌🏾🙌🏾🙌🏾

[@AskTheBiller]

❤️❤️😊

[@abbystuthers4338]

This really clarified things for me (I'm an NP.) Let's say a patient's primary insurance is Medicare bur they have a secondary insurance, e.g., a Medicare supplement plan. I am an in-network Medicare provider but not in-network for their supplement. Do I do the calculations described in the video using Medicare numbers? Will you eventually do a video about not in-network provider calculations? Thanks so much! Very best, Abby Stuthers, NP

[@feltondavon69]

Thank you so much very informative 👍

[@AskTheBiller]

So glad it was informative. Thank you for watching!

[@britneyharris1994]

Thanks so much I needed this !!

[@AskTheBiller]

You are so welcome! Thank you for watching.

[@tahirraza3532]

Only 10 comments for this very precious video...... I think still people don't know about medical billing or i think 90% of people..... They became owners of individual medical billing company 😁🤣

[@abijithvlogs]

Oooh my god the way u taught really helped me a lot .without doing this problem i failed in my assessment from training so i lost my job . And now i got selected in another company i am very much confident to crack the assessment ...... I never forget yours help thankyou so much.

[@AskTheBiller]

You’re welcome!! Good luck. Let me know if you get the job.🙏🏾😁

[@simryusom8811]

Thank you so much!!!!

[@AskTheBiller]

You're very welcome!☺

[@MegaMermaidgirl]

this is great. yu explain very well

[@AskTheBiller]

thanks so much!

[@mafullgaming]

Very good informative video 👍

[@user-jc8mx7hm1z]

You are an amazing teacher!! Thank you so much, Quiana! :)

[@AskTheBiller]

Thanks so much, Jeanette 🫶🏾

[@AskTheBiller]

Thanks so much, Jeanette 🫶🏾

[@julierodriguez7140]

So helpful! Thank you!

[@AskTheBiller]

Thanks for your feedback.❤️

[@entertainmentkiduniya3526]

It's a really helpful for me. Thanks 👍

[@AskTheBiller]

You're welcome!

[@starvijay7689]

Very nice explanation 🎊

[@sabrinawatson9981]

This is so helpful. I understand it way better this way. I went to school for medical office and billing specialist last, completed the course but do work in the field because I didn’t quite understand what I was doing but you have explained this wonderfully. I now have confidence to take the exam and get off into the field. Really wish there was some out there that could explain coding like this.

[@AskTheBiller]

Thank you so much, Sabrina! I can refer you to great coding instructors. Feel free to email me at [e-mail]. Best of luck with your exam : )

[@babybearbethea7310]

Hello my name is Jacqueline Denise Bethea I am in school now doing Medical Billing and Coding online I am very interested in doing your group I like the way how you break everything down so I can understand better so tell me how can I join the group thank you again, Jacqueline Bethea.

[@AskTheBiller]

@@babybearbethea7310 please visit www.JustAskTheBiller.com to enroll.😊

[@keyshianorman6]

WOW I understand that awesome THANK YOU

[@AskTheBiller]

Perfect! You’re welcome.😁

[@checheleena]

So happy I found your Channel.❤ #5 stumps me still a bit. Why did we subtract the deductible but then add it back to the patient coinsurance?

[@AskTheBiller]

Me too, thank you!❤ The insurance is going to subtract unmet deductible when calculating their reimbursement. It gets applied to patient responsibility so that amount has to be added back in along with the coinsurance. Make sense?

[@avegailcastanetas1507]

thank you!! this is so helpful

[@AskTheBiller]

You’re very welcome! Thanks for watching ❤️

[@princessbejai3276]

Thank you!

[@josephpage4303]

Loved your video! I just have a few questions about medical billing: firstly, is it possible to get into medical billing in a behind-the-scenes role? I'm interested in the field but would prefer a role that's not front desk. Also, do employers train you in understanding the insurance guidelines?

[@AskTheBiller]

Thank you! When you say "behind the scenes role" what exactly do you mean? Not having direct contact with patients? That is possible. It depends on the scope of work you are hired for. You may not have to handle any patient inquiries and solely focus on working the claims. Most medical billers do not receive formal training and learn as they go. You can go to the insurance payers websites and see what resources they have available.

[@TO-il3vc]

Does the "No Surprises Act" affect the way you balance-bill patients? Is it still legal to balance-bill?

[@thebeautybanga]

Amazing 🤩 explanations

[@AskTheBiller]

Thank you for your feedback ❤️

[@melisamarquez8583]

I just finished my Administrative Medical Assistant course and i learn about medical billing and coding, you explained it very easy. Can you please provide me with the zoom information about yure class.

[@AskTheBiller]

Hi Melisa. Thanks for watching! Here is the link with details for my billing and software training course. askthebiller.myshopify.com/products/1621013

[@carromplay3415]

Great Information 👍. But in example 5 i still didn't clear why you subtract the deductible amount from the allowed amount.

[@tahirraza3532]

Very informative video ma'm you reminded me the stuff i forgot........ It's been a long time to left medical billing..... On monday I'm gonna face HR for medical biller....

[@AskTheBiller]

Thanks for watching! Best of luck!

[@tahirraza3532]

I'm working in a billing company with AR professionals and I am enjoying a lot...... Thanks to ALMIGHTY and your videos are very helpful thanks a lot 😇👍

[@tahirraza3532]

Today's I was watching your videos again and I found my previous comments with your reply I felt smiley 😇😇

[@janeannemontenegro3428]

Hi I'm new to your channel and I love your videos. Thank you so much for making such informative videos. Was just wondering what happens to adjustments? Is the amount the provider is willing to let go? Or should this be including for ptx oops? Thank u in advance. More power!

[@AskTheBiller]

Hi Jane. Thanks so much for watching and for the positive feedback! When a provider signs a contract and is in network/participating with a plan, they have agreed to accept specific rates for each CPT/HCPCS code as payment in full. So the adjustment is let go as you stated because the amount in excess of the contracted rate has to be written off of the patient's account. Hope this answers your question. Take care!

[@mockingjaye3024]

This was great!

[@AskTheBiller]

Thank you! I’m glad it was helpful.😊

[@alisa-franco]

I'm going to school for medical records specialist but I'm having a very hard time doing deductibles and co-pays and all of that adding them just like you showing your video which was very helpful do you have more examples and more of a breakdown on how to do that

[@AskTheBiller]

This is the only tutorial I have on medical billing calculations but stay tuned for new content!

[@elfacua14]

is there a video for the calculation with secondary insurance?

[@sewingseeds.]

Referreing to Example #5: Is the "Provider" able to keep the unmet deductible plus what was covered by the insurance? So the total income received is $5866. Did I get that correct? Thank you so much .

[@bernfran1313]

Hello. I am currently in the Medical Billing part of my online Medical Coding Course. Learning who pays first when multiple agencies invilved. Trying to understand why all don't charge the same and pay the same...

[@robinson2589]

So i am reading over my CPC study guide. I don’t understand the RBRVS, work RVU scale thing. Is knowing how to calculate facility or non facility pricing amounts more of a coding thing or billing thing?

[@aquariusguard]

That was so helpful. Are those the only scenarios or is there another scenario where instead of the unmet deductible it's out of pocket maximum unmet?

[@AskTheBiller]

Unmet out of pocket maximum is very common. That just simply means the patient continues to pay their copay, coinsurance and/or deductible. Once the out of pocket maximum has been met, the patient will no longer have out of pocket costs until their next plan year. So if they meet their out of pocket maximum on June 1st and their plan renews on January 1st from June 1st through December 31st the patient would not pay anything since the insurance will pay 100% of the allowed charges. Hope this helps!

[@wrightnyree8215]

So example 3 the adjustment is $260 this giving be written off? Because the patient is only responsible for paying the $330 allowed amount due to not met their ded?

[@Foxz90]

How do you get the allowed amount please and thank you? I'm taking a class and I'm so confused. Your video did help much more than my instructor 🤦🏽‍♀️🙏🏼

[@AskTheBiller]

Hi Crissy. The allowed amount is determined by the insurance payer. If the provider is in network (they have signed a contract/agreement with the insurance) the allowed amount is predetermined and can be disclosed by provider services. The provider should have access to the fee schedule with the CPT/HCPCS codes and the allowed amounts. Unfortunately, I hear this frequently. A lot of students are not satisfied with their instructors. But I am happy to be a resource! Take care.

[@shwetainamdar6326]

This was very helpful, can you explain what happens to adjustment?

[@AskTheBiller]

I’m glad to hear that!😊 An in network provider accepts the total “allowed” amount as reimbursement in full. So the adjustment, which is the difference between what was billed and what was allowed, is written off of the patient’s account.

[@lisagiovino9092]

This video is awesome !!! Do you still teach the class? I may be interested.

[@AskTheBiller]

Thank you, Lisa. Yes! I have an online billing and software training course. Please email [e-mail] for the details!

[@fuyit16]

How did you get the $40 copay on the first example???

[@capricornium2033]

Hi Quiana. I am really new to insurance and medical billing. In your example 4, why is that the patient responsibility is 0USD and what does remainder of their benefit year means? And does the adjustment is the amount the patient is going to pay? Thanks a lot and it will be a big help for me.

[@AskTheBiller]

The patient responsibility is $0 because their "out of pocket maximum" has been reached. Once that amount has been reached the insurance will cover 100% of the allowed amount. Their benefit year can run on a "calendar" year, Jan 1 to Dec 31, or a "plan" year which may start on any other day of the year. This is the time period for when their benefits are eligible. Their benefits could possibly change or terminate at the end of the benefit year. The adjustment (or the amount written off) is the amount not covered. The adjustment is not the patient's responsibility if the provider is in network and participates with the plan.

[@wrightnyree8215]

Example 4 is this a scenario when a patient don’t have an ded but have an OOP with a coinsurance?

[@faithsteph2994]

Hi, thanks for this informative video! I have a question tho,, Can copays, deductibles, and coinsurance vary per service? Thanks in advance.

[@AskTheBiller]

You're welcome, Faith. Thanks for watching! Absolutely. Patient responsibility does vary based on the service being rendered. It also can vary based on the location. A patient may have a different copay for services rendered in the office vs via telehealth vs in a facility. A patient's deductible may be applicable for office visits and procedures but not for annual physical exams.

[@asadmian2274]

In your example 5, Is it possible that the remaining unmet deductibles are gradually deducted from the patients instead of full amount on the treatment from the patient.

[@pranavpanchal7501]

Awesome 👍

[@SocaTrain]

Could you possibly do a video on patient insurance eligibility/verification please?

[@AskTheBiller]

I sure will : )

[@DAASAREESHREEDHARH]

Hi what happen after deductible met whether the insurance pay total bill after deductible met it's correct please reply

[@andreabruns8939]

This is a great video It just leaves one question what happens to the adjustment amount? Does the patient has to pay this as I assume it was billed to the patient and the insurance reimburses only the % of the allowed amount? Thank you for your advice

[@AskTheBiller]

The adjustment is the amount written off. The patient is not responsible for that amount. Thanks for watching!

[@andreabruns8939]

Wonderful, Thank you so much for clarifying!

[@georginagibson30]

That was really helpful. My job, which is adjustment, is for a hospital. I'm being trained by someone who isn't very helpful. Since he has been employed by the company for more than 8 years, he is qualified to examine the account and determine where adjustments are required. Contrary to me, who comes from a nursing home and handles private billing, this is completely foreign to me. I'm not sure whether you can help with this, but if you can, that would be really appreciated.

[@AskTheBiller]

Thanks for watching and I’m glad you found it helpful.😊 I don’t do facility billing. Only professional billing.

[@georginagibson30]

@@AskTheBiller Okay thank you

[@crystalgoudie]

How can you tell if there is a contractual adjustment? All the fields that the EOB I'm looking at provides is: Fee charged, PDP (if applicable), covered expense, benefit paid. If there is something in the PDP fee column does that indicate a contractual adjustment?

[@AskTheBiller]

Some of the insurance payer EOBs are more thorough than others. The best thing to do is to contact the payer and have them confirm the contractual adjustment amount. It may be on their portal/website or you can call provider services and speak with a live representative. Hope this helps!

[@kennethroxas2984]

Can you enlighten me with this one? This is an example from our training. Heres the only information provided including the questions. Thank you so much in advance. Scenario: Mark has an insurance policy with 100 Usd monthly premium , a 1000 USD deductible and a 5000 USD out of pocket maxim. He broked his leg and got a hospital bill of 10000 usd , how much of this bill he has to pay? How much is total expenses of mark considering his deductibles and out of pocket? How much of total expenses will be covered by the insurer?

[@AskTheBiller]

Hi. This is not enough information. In order to calculate his responsibility, I would need to know the allowed amount on the claim and how much of his deductible and out of pocket max has been met.

[@natachaharrison6908]

Understood!!

[@AskTheBiller]

Great! Thanks for watching.

[@animeshmohanty7855]

Just one question. So who pays the adjustments amount? Is it the patient?

[@annat9739]

Where did you get the billed amount and the allowed amount? Is billed amount the amount of service to pay?

[@AskTheBiller]

The provider determines the billed (charge) amount and the insurance payer determines the allowed amount.

[@lilianamartinez426]

We are out of network provider , Can you do a video on that?

[@AskTheBiller]

I will add this to my list : )

[@chantellstubblefield-bagle2952]

Hi Quiana, I just recently started working at a hospital in the Revenue Billing Cycle Dept. I am actually a Refund Clerk. I am having a lot of trouble trying to learn how to do Adjustments. I was wondering, is there anything you can help me with on this to learn and do my job better? Thank you

[@AskTheBiller]

Hi Chantell. I would love to help you but I would need more specific details. Question, did the hospital or your manager not provide any training?

[@meghanabns9061]

Hey Quiana, Can you do a video on how does the provider credentialing work. Like, when we receive rejections from clearing house that the provider is not on file. Or the provider contract is expired?? How do we resolve those kind of rejections/denials.

[@AskTheBiller]

Hi Meghana. Thank you for the video suggestion but I do not offer credentialing services. If you are experiencing those types of denials you should contact the insurance provider services department. The rep will tell you the next steps to take to get the claim processed. If the provider is out of network and the patient does not have out of network benefits, unless it was an emergency there will likely be no reimbursement. Take care.

[@meghanabns9061]

@@AskTheBiller thank you 😀

[@leticiaacosta781]

I love your video too!! what about out of network benefits?

[@AskTheBiller]

Thank you, Leticia : ) I have to make a video discussing out of network reimbursement.

[@leticiaacosta781]

@@AskTheBiller thank you

[@markuzantwahn6351]

Do any of the out of pocket expenses accumulate towards the deductible? For example, if a person goes to the doctors office and pays co-pays or coinsurance throughout the year. Do those out of pocket costs go towards the deductible (until it's met) and then taken out of the total out of pocket maximum- until thats met?

[@AskTheBiller]

Hi Markuz. It depends on the plan. Some plans will apply all out of pocket expenses (copays, coinsurance and deductible) to the "out of pocket maximum". But copays and coinsurance do not get applied towards deductible. That is a separate out of pocket expense that accumulates on its own.

[@markuzantwahn6351]

@@AskTheBiller thank you very much 😊 I appreciate the quick response!

[@clarepierce1872]

Hi, my question is: If the patient has a primary and secondary Insurance. The primary deductible is 1,000 and has not met. Do you bill the secondary Ins. Prior to collecting the primary deductible? Ty in advance your video was excellent! Clare

[@AskTheBiller]

Yes, that’s exactly what you should do! Thanks for watching.😊

[@clarepierce1872]

@@AskTheBiller 🙂

[@annaperezlara91]

Thank you for explanation, a QUESTION. Does your deductible meet by service date or by claim date? I have Aetna, and could not find any info (standard saving)

[@AskTheBiller]

Deductibles accumulate according to the date the claim was processed. For example, if you submit a claim with DOS 1/15/24 that processes on 1/30/24 and applies to deductible it’s possible that a claim with DOS 1/2/24 submitted in March processes and pays because deductible was met when the claim was received. Does that make sense?

[@annaperezlara91]

@@AskTheBiller yes, first come-first serve. How about DOS from last yest 12/23/23 and claim was done 1/4/2024, does the same principal apply? Will that cost go towards this year deductible since claim was received this year. When i called insurance they said they go by CLAIM DATE, not the date of service, yet refusing to apply this clam towards deductible for this year.

[@AskTheBiller]

@@annaperezlara91 they are correct. A claim with a 2023 DOS that is processed in 2024 will get applied towards the 2023 deductible.

[@michaelenemacke4471]

I am a registration clinic. I understand the copay part but when it comes to what the patient owes before they see the doctor with a deductible that's either met or not bet how do you figure their cost

[@AskTheBiller]

Hi Michaelene. If the provider is "in network" and participates with the patient's plan, they have signed a contract with the insurance company and agreed to specific rates for each service. If the patient is coming in for a follow up visit you would look up the code on the fee schedule to confirm the "allowed" amount. If the patient's deductible has not been met and it exceeds the allowed amount you can charge the patient the allowed amount upfront. So for example, the patient has a $1000 deductible, $100 has been met and they are coming in for a follow up visit. The CPT is 99213 and the allowed amount is $150. You can collect $150 upfront at the time of service and submit the claim. After the claim processes confirm on the EOB (explanation of benefits) that the allowed amount and the amount applied to the deductible matches what you charged the patient. If more was applied to the deductible you would balance bill the patient the difference that they owe. If less was applied to the deductible you would refund the excess amount collected to the patient. And if a payment was made by the insurance payer and nothing was applied to deductible you would refund the patient $150. Hope this helps!

[@shandysawyer]

How would you calculate example 5 if they had not yet hit their out of pocket maximum but the patient responsibility of $4588 would put them over their out of pocket maximum?

[@AskTheBiller]

Hi Shandy. The patient would only be responsible for the amount up to the out of pocket maximum. The EOB will show the amount up to their OOP max and then the insurance would pay the excess amount. Once their OOP maximum is reached the insurance will pay 100% of the "allowed" amount until their benefit year ends.

[@jackyespinoza4835]

Whatttt you can schedule a consultation I NEED THAT WITH You!!!

[@AskTheBiller]

Absolutely! LOL. Head to my website www.justaskthebiller.com, select services, then consultation call. Thank you : )

[@bernfran1313]

Interesting

[@kaykay1974]

Thank you! Are you still doing the courses via Zoom?

[@AskTheBiller]

My medical billing course is pre recorded and self paced. In addition, we meet live weekly via zoom for Q&A. Please visit my website www.JustAskTheBiller.com for details or email me at [e-mail]. Thank you!

[@beautybrainsbrawn]

Hello, I am still confused about how to calculate the write off amount. Is there a specific formula that I need to use to calculate or determine it. In what ways there is no write off amount?

[@AskTheBiller]

Yes, for in network claims the formula to calculate the write off amount is “the allowed amount aka the contracted rate - the paid amount = the adjustment aka the write off amount.

[@stvnrnzl4778]

How to know or compute specific deductible per service? Example, deductible is $6500/plan year, patient will have $300 xray service, how much is the deductible and how much for insurance reimbursement on this specific service? Asking from PH, thanks! 💜💜

[@eastbayivxx510]

If deductible isn’t met, the service is going to cost you $300.

[@antoniaantonia3337]

Hello good evening I did Medical Billing years ago and would like a refresher course as I started a new job that includes medical Billing. How can I be a part of your class

[@AskTheBiller]

Hi Antonia. My refresher course covers the fundamentals of the entire revenue cycle. Here is the link and you can enroll anytime. Thank you! askthebiller.myshopify.com/products/1621013

[@aspicegyal]

My textbook could never😭😭 Thankyou

[@AskTheBiller]

🤣 Hilarious! So glad I could help.

[@MegaMermaidgirl]

got a silly question. i dont know if yu have employees or not but if yu want to take a vacation and yu r handling a providers billing do yu take your laptop with yu so yu can get done? i think it was your channel where i heard yu have a certain amount of time to file a claim

[@AskTheBiller]

Yes, you can take a laptop on vacation and work remotely from anywhere in the world. On average you have about 90 days to submit a claim so taking a few days off is perfectly fine. Some insurance payers like Medicare allow 365 days to submit. So the ability to take a vacation is not an issue.

[@MegaMermaidgirl]

@@AskTheBiller thank you so much. i start my billing course on april 11. nervous and excited. i love your channel and that you help so many with your knowledge. ❤️

[@user-xw3cp4uj1f]

I have a question pertaining to how the provider is payed. If a patient has a large deductible, does the reimbursement go to the provider or is it the patients responsibility to pay the provider. We have cases where the patients deductible was payed down and the provider received nothing.

[@AskTheBiller]

Hi. When the allowed amount is applied to deductible and the insurance pays $0, you have to bill the patient. The patient has to pay the amount applied to patient responsibility.

[@user-xw3cp4uj1f]

@@AskTheBiller Thank you!

[@annadisney2288]

How do you calculate the patient out of pocket amount when there is a secondary insurance? In this case Medicare is primary and the secondary has a 10% coinsurance. You’re the best!

[@AskTheBiller]

Hi Anna. Thanks so much : ) It depends! If Medicare applies the charges allowed to the patient's deductible, the secondary insurance may or may not pay. Some secondary plans do not cover deductible. But if Medicare does make a payment, the remaining 20% is what the secondary insurance would consider and then the patient may be responsible for 10% of that remaining balance. It's hard to say! I would just explain the benefits as far as deductible and coinsurance. I don't think I would specify a dollar amount in this case.

[@jaymarkjuan5928]

are there any payment for the seminar?

[@AskTheBiller]

The online billing and software training course I offer is $997. Thank you.

[@janleoung7237]

How does copay works when there is a secondary insurance?

[@AskTheBiller]

Submit the claim to the primary insurance. When you receive the primary EOB, submit it with the secondary claim and see if they pay the primary copay. If not, bill the patient.

[@thebeautybanga]

How do you find out what the allowed amount is?

[@AskTheBiller]

There’s an insurance fee schedule with the allowed amounts aka contracted rates.

[@Dana-kc7gl]

What do you mean by allowed amount?

[@AskTheBiller]

The allowed amount is the amount allowed by the insurance. A provider may bill $300 for a a service but the insurance company may only allow $200. If the provider participates with the insurance plan, the difference of $100 would be written off.

[@ivettereyes6646]

Plz more sample so if they have a 2000 deductible in network and have a copay of 25 dollar they pay 25 everytime they come in correct